The more time adolescent girls spend in front of Facebook, the more their chances of developing a negative body image and various eating disorders, such as anorexia, bulimia and exaggerated dieting. This has been shown in a new study from the University of Haifa.

Eating disorders include a wide spectrum of abnormal mental and behavioral conducts related to food and body weight, such as anorexia nervosa and bulimia nervosa. This study, conducted by Prof. Yael Latzer, Prof. Ruth Katz and Zohar Spivak of the Faculty of Social Welfare and Health Sciences at the University of Haifa, set out to examine the effects of two factors on the development of eating disorders in young girls: exposure to the media and self-empowerment.

A group of 248 girls aged 12-19 (average age: 14.8) took part in the survey. These girls were asked to provide information on their Internet and television viewing habits. Regarding the latter, they were asked to give the number of popular shows related to extreme standards of physical image (the “Barbie” model) that they watched. The girls also filled out questionnaires that examined their approach to slimming, bulimia, physical satisfaction or dissatisfaction, their general outlook on eating, and their sense of personal empowerment.

The results showed that the more time girls spend on Facebook, the more they suffered conditions of bulimia, anorexia, physical dissatisfaction, negative physical self-image, negative approach to eating and more of an urge to be on a weight-loss diet. Extensive online exposure to fashion and music content showed similar tendencies, but manifested in fewer types of eating disorders. As such, the more the exposure to fashion content on the Internet, the higher a girl’s chances of developing anorexia. A similar direct link was found between viewing gossip- and leisure-related television programs (the likes of “Gossip Girl”) and eating disorders in adolescent girls. The study also revealed that the level of personal empowerment in these girls is negatively linked to eating disorders, such that the higher the level of empowerment, the more positive the physical self-image and the lower the chances of developing an eating disorder.

In this study, exposure to the media and the consequential sense of personal empowerment was found to be associated to parenting practices. Girls whose parents were involved in their media usage; who knew what they were viewing and reading and where they were surfing on the web; who watched, surfed or read along with them; and who conducted cooperative and critical discussions with their daughters about the content of their surfing habits, showed more personal empowerment, forming a protective shield against eating disorders.

On the other hand, parents who were not involved in their media exposure, were not aware of the content that their daughters were consuming, and instead of sharing and becoming familiar with that content chose to limit or prohibit exposure, led to lower self-empowerment in their daughters. This, in turn, has a positive link to various eating problems and negative body image.

“Significant potential for future research and application of eating disorder prevention lies in an understanding of how parenting decisions can have effect on an adolescent girl’s sense of empowerment and that enforcing a girl’s sense of empowerment is a means to strengthening body image. This study has shown that a parent has potential ability to prevent dangerous behavioral disorders and negative eating behavior in particular,” the researchers stated.

With eating disorders on the rise among boys, minorities and younger children, doctors need to keep an eye out for unexpected cases, according to the author of a new report. The stereotype that eating disorders affect only affluent, white teenage girls no longer applies, said David S. Rosen, MD, MPH, who wrote a clinical report on the topic that was published in the December issue of Pediatrics. “It’s also happening to boys, young children, people of color and middle-aged women. It’s more of an equal opportunity disorder,” said Dr. Rosen, a professor of pediatrics, internal medicine and psychiatry at the University of Michigan.

Males, for example, now represent up to 10% of all cases of eating disorders. The number of children younger than 12 who are hospitalized for eating disorders increased 119% from 1999 to 2006, according to an analysis by the Agency for Healthcare Research and Quality cited in the report (www.ncbi.nlm.nih.gov/pubmed/21115584/). Young children who develop eating disorders are more susceptible to serious medical consequences such as stunted growth and organ damage, Dr. Rosen said.

Early intervention recommended

He urges physicians, nurses, parents, school social workers and others to intervene early. Health care professionals should take note when patients, particularly young ones, make derogatory comments about their appearance or talk about going on a diet. The report said screening questions about eating patterns and body image should be asked of all preteens and adolescents.

Fewer than 1% of adolescent girls in the U.S. have anorexia, and 1% to 2% percent have bulimia. Experts estimate that between 1% and 14% of Americans exhibit some physical and psychological symptoms of an eating disorder. Male and female athletes, including gymnasts, runners and wrestlers, and performers, such as dancers and models, may be more at risk.

The report said eating disorders may have more of a genetic link, similar to alcoholism and depression, than previously thought. The discovery that some children may be genetically predisposed to the condition may “help to take away some of the blame or stigma,” Dr. Rosen said. With more children obese, physicians should choose their words carefully when counseling a child about his or her weight, Dr. Rosen said. He sees young patients with eating disorders who claim their problems with food began when their doctor told them to lose weight.

Dr. Rosen recommends that physicians discuss healthy eating practices, not dieting, with patients and focus on a healthy lifestyle, not losing weight. “There’s a perception that, like alcoholism, [an eating disorder] never goes away and that the best you can do is keep it under control,” he said. But if caught early, “most children and teens can expect to recover completely.”

As an example of a picky eater who would not be classified as having an eating disorder, Marcus referenced a woman who spoke on a radio program recently. The woman declared herself “the pickiest eater I've ever met” and explained that the thought of eating any cooked vegetable made her sick, though she didn't mind them raw.

“That is not a disorder,” said Marcus. “She has plenty of other foods to choose from and it's not affecting her health or well-being.”

In her practice at Western Psych, Marcus doesn't see many adults that she would classify as having such a disorder. “I think people don't identify themselves as having an eating disorder and it hasn't been considered an eating disorder,” she said. “They don't come to us.”

At Duke, Zucker encounters adult picky eaters mainly as the parents of children that she is treating for picky eating or other eating disorders.

Adults who are picky tend to like bland foods that are comfortable and colorless, said Marcus, such as plain pasta or french fries.

In both children and adults, picky eating can be caused by “food neophobia,” otherwise known as the fear of new foods, by sensory sensitivity to particular textures, or by traumatic experiences such as forced eating.

“It's been a pretty poorly operationalized construct — what it means to be a picky eater,” she said. “There's a lot of different definitions floating around. What we'll find is a huge continuum — we all have food quirks.”

To this end, the following emotional variables have been specified: those relative to emotional experience —the frequency of positive and negative emotions, anxiety, low self-esteem and the influence of diet, weight and the body shape on the emotional state—; negative perception of emotions, negative attitude to emotional expression, alexithymia —the inability to identify own emotions and to express them verbally— and the manner of controlling negative emotions.

Moreover, another variable has also been taken into account: the need for control. This variable is not strictly emotional, but has a clear emotional component, given that people with a high need for control, experience anxiety and unwellness when perceiving lack of control.

Study of women

In order to undertake the study, 433 women took part; 143 of these suffered from some kind of eating disorder and 145 in risk of contracting one. The results of the study show that, in general, the majority of the variables put forward can be used as predictive of suffering an eating disorder. The variables which, above all, alert to greater risk of developing an eating disorder are when the emotional state of the person is excessively influenced by diet, weight and body shape, when self-esteem is low, and when, in anxiety situations, emotions are not expressed and the person tends to act in an impulsive manner.

These results have important implications, above all when drawing up prevention programmes for eating disorders. With the data obtained, it can be said that many of the emotional variables dealt with in Ms Pascual's work should be taken into account when drawing up these prevention programmes.

Serious illnesses

Eating disorders are very serious illnesses that have dire consequences for the sufferer, both physically as well as psychologically and socially, and there are disorders that are evermore widespread. Much research has been undertaken in order to find out the factors involved in their development, but the role played by the various emotional variables at the onset of these disorders has hardly been investigated. This thesis presented at the UPV/EHU focused on this matter more deeply.

Using the results of Project EAT-II: Eating Among Teens, researchers from the College of Saint Benedict and Saint John's University, the University of Minnesota, and the University of Texas, Austin, analyzed the diets, weight status, weight control behaviors, and drug and alcohol use of 2,516 adolescents and young adults between the ages of 15 and 23. These participants had been part of Project EAT-I, an earlier survey of middle school and high school students from 31 Minnesota schools using in-class surveys, food frequency questionnaires, and anthropometric measures taken during the 1998-99 academic year.

Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Subjects were divided into two cohorts, an adolescent (15-18) group and a young adult (19-23) group. They were questioned about binge eating and whether they felt a loss of control of their eating habits. More extreme weight control behaviors including taking diet pills, inducing vomiting, using laxatives, and using diuretics were also measured.

The authors found that among the younger cohort, no statistically significant differences were found with regard to weight status. Among the older cohort, current vegetarians had a lower body mass index and were less likely to be overweight or obese when compared to never vegetarians.

Among the younger cohort, a higher percentage of former vegetarians reported engaging in more extreme unhealthy weight control behaviors when compared to never vegetarians. Among the older cohort, a higher percentage of former vegetarians reported engaging in more extreme unhealthy weight control behaviors when compared to current and never vegetarians.

In the younger cohort, a higher percentage of current and former vegetarians reported engaging in binge eating with loss of control when compared to never vegetarians. In the older cohort, a higher percentage of current vegetarians reported engaging in binge eating with loss of control when compared to former and never vegetarians.

Writing in the article, Ramona Robinson-O'Brien, Assistant Professor, Nutrition Department, College of Saint Benedict and Saint John's University, St. Joseph, MN, states, “Study results indicate that it would be beneficial for clinicians to ask adolescents and young adults about their current and former vegetarian status when assessing risk for disordered eating behaviors. Furthermore, when guiding adolescent and young adult vegetarians in proper nutrition and meal planning, it may also be important to investigate an individual's motives for choosing a vegetarian diet.”

Several maladaptive eating behaviors, beyond anorexia, can affect women. Indeed, some 10 to 15 percent of women have maladaptive eating behaviours and attitudes according to new study from the Université de Montréal and the Douglas Mental Health University Institute published in the International Journal of Eating Disorders.

“Our results are disquieting,” says Lise Gauvin, a professor at the Université de Montréal Department of Social and Preventive Medicine. “Women are exposed to many contradictory messages. They are encouraged to lose weight yet also encouraged to eat for the simple pleasure of it.”

Some 1,501 women took part in the phone survey on eating disorders and disordered eating. Not one participant was classified as anorexic. The average age of these urban-dwelling participants was 31, the majority of respondents were non-smokers and university graduates.

Dr. Gauvin says the study sheds new light on binge eating and bulimia, which are characterized in part by excessive eating accompanied by feelings of having lost control. “About 13.7 percent of women interviewed for this study reported binge eating one to five days or one to seven times per month,” she says, noting 2.5 percent of women reported forcing themselves to vomit, use laxatives, or use diuretics to maintain their weight or shape.

The investigation also established a link between problematic eating behaviours and self-rated health. In other words, deviant eating behaviours are more likely to occur in women who perceived themselves to be in poor health.

Another finding of the study was that 28 percent of women complete intense exercise twice a month with the sole objective of losing weight or influencing. “We practice a sport for the pleasure it provides, to feel good, but when the activity is done to gain control over one's weight and figure, it is indicative of someone who could be excessively concerned about their weight,” says Dr. Gauvin. “Our data suggests that a proportion of the female population displays maladaptive eating patterns.”

This study was supported by the Canadian Institutes for Health Research.

While vegetarians tend to eat healthier diets and are less likely than non-vegetarians to be overweight or obese, they may be at increased risk for binge eating with loss of control, and former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors, according to researchers at University of Minnesota, University of Texas and St. John's University.

The researchers analyzed vegetarianism, weight, dietary intake and weight-control behaviors data from a population-based study in Minnesota of more than 2,500 males and females between 15 and 23. They found vegetarians ate healthier diets than non-vegetarians when it came to fruits, vegetables and fat intake. Among young adults, current vegetarians were less likely to be overweight or obese.

However, adolescent and young adult vegetarians were also more likely to report binge eating with loss of control compared to non-vegetarians. Among adolescents, former vegetarians were more likely to engage in extreme unhealthful weight-control behaviors. And among young adults, former vegetarians were more likely to engage in extreme unhealthful weight-control behaviors than people who either were currently vegetarians or had never followed a vegetarian eating plan.

The researchers conclude: “Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults attain the added benefit of decreased risk for overweight and obesity. However, vegetarians may be at increased risk for disordered eating behaviors, such as binge eating and unhealthful weight-control behaviors.

“Study results indicate that it would be beneficial for clinicians to ask adolescents and young adults about their current and former vegetarian status when assessing risk for disordered eating behaviors. Furthermore, when guiding adolescent and young adult vegetarians in proper nutrition and meal planning it may also be important to investigate an individual's motives for choosing a vegetarian diet.”